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Neuropsychological Rehabilitation

Neuropsych Assessment

  Rehabilitation requires a team approach   Design evaluations to aid treatment team   Identify breadth and depth of deficits   Identify remaining strengths

Neuropsych Assessment

  Must be creative   Range and severity of deficits is huge   Treatments must be tailored to the individual

  Supplement standardized testing with Applied Behavioral Analysis

  Recovery timeline is important

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Neuropsych Assessment

  Ecological Validity  Neuropsychological tests may not

“transfer” or relate to the “real world”  Behavioral and Task analysis can bridge

the gap  Develop more ecologically valid tests

 Rivermead Behavioural Memory Test

Approaches to Rehabilitation

  Function (Restitution)  Focus on underlying impairment

  Performance (Substitution)  Focus on compensation

1. Restitution of Function

  Assumption 1: Damaged cognitive processes can be repaired   Stimulation/activation paradigms   Example: Memory retraining

  Assumption 2: Exercises will result in neural changes as well   Plasticity in the CNS noted   Not well correlated with cognition

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2. Optimization of Residual Function

  Assumption: Cognitive ability isn’t lost, but only inefficient   Normal aging or mTBI   Process-oriented assessment can help

identify inefficiencies   Involves training specific strategies

  Mnemonic strategies   Skills available premorbidly

3. Compensation for Lost Function

  Assumption: Cognitive and neural processes cannot be restored

  Makes use of external supports   Environmental restructuring   Compensatory devices

  Sometimes it’s the ONLY option   Severe brain damage

4. Substitution of Intact Function

  Assumption: Other intact processes may be recruited

  Improve functional outcome and possibly alter underlying neural processes

  Best for severe cognitive problems but minimal functional loss

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Specific Strategies: APT

  Attention Process Training (APT)   Sohlberg and Mateer   Sustained attention   Selective Attention   Alternating Attention   Divided Attention

Specific Strategies: Memory

  Practice and Rehearsal  Repeated practice and drills  Spaced retrieval (Landauer & Bjork,

1978)  Retrieve information  Gradually increase time intervals  Capitalizing on implicit memory?

Specific Strategies: Memory

  Mnemonic Strategies  Typical mnemonics (e.g., imagery)

effective only in special circumstances  Limited generalizability  Encoding versus Retrieval training

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Specific Strategies: Memory

  External Aids (e.g., Sohlberg & Mateer, 1989)   Memory notebooks, diaries, alarms,

calendars, etc.   Considerable training necessary   Best for mild impairments   BUT: Pagers/voice organizers helpful for more

severe problems

Specific Strategies: Memory

  Vanishing Cues (Glisky & Schachter, 1987)   Teaches large amount of complex knowledge   Example: Job skills   Provide structured cues, gradually withdrawn

as learning progresses   Possibly taps into implicit memory systems

Specific Strategies: Memory

  Errorless learning (Baddeley & Wilson, 1994)   Explicit memory is needed to learn from

mistakes   Preventing mistakes capitalizes on intact

implicit memory

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Errorless Learning

  I’m thinking of a 5-letter word beginning with QU. Can you guess?

  No, but good guess. The correct word is…

  Test: One word began with QU. ?

  I’m thinking of a 5-letter word beginning with QU and the word is QU _ _ _. Write that down.

  Test: One word began with QU. ?

Errorful Learning

Errorless Learning

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Errorless Learning: Applications

  Teaching new skills   Typing   Meal preparation

Assessing Success

  Task Improvement   Did performance improve?

  Generalization to Neuropsych Testing   Do we see gains on related tests?

  Generalization to Daily Functioning   Do the gains transfer to daily life?   HERE is the biggest problem